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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 33  |  Issue : 3  |  Page : 333-335

Mucosal burning: A case report of rare finding in maxillary sinus carcinoma


1 Department of Oral Medicine and Radiology, Dr. D.Y Patil Dental College and Hospital, Pune, Maharashtra, India
2 Department of Periodontology, Dr. D.Y Patil Dental College and Hospital, Pune, Maharashtra, India

Date of Submission23-Jan-2021
Date of Decision04-Jul-2021
Date of Acceptance05-Jul-2021
Date of Web Publication28-Sep-2021

Correspondence Address:
Dr. Shriya Dinesh Temgire
707, State Bank Colony, Shirur, Pune, Maharashtra - 412 210
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_22_21

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   Abstract 


Malignant tumors in the maxillary sinus (MxS) are rare and are usually diagnosed when perforating the sinus walls in the later stages. Asymptomatic growth of the malignancy is facilitated by the presence of large air space in the MxS. The clinical presentation depends on the sinus wall involvement by the tumors. Symptoms of maxillary sinus carcinoma (MxSCa) can resemble dental infection that the affected patients may visit dental clinics for seeking treatment. This report presents a case of MxSCa, which was secondarily infected along with the rare clinical finding and chief complaint being severe mucosal burning. Attention toward these rare symptoms should be considered, as cases have not been reported with symptoms of burning sensation in MxSCa. Advanced imaging modality such as computed tomography for prompt identification of such lesions is discussed. The patient's first diagnosis is mostly in an advanced stage with a poor prognosis.

Keywords: Asymptomatic, Burning sensation, Computed tomography (CT), High-grade carcinoma, Maxillary sinus (MxS), Mucosal burning


How to cite this article:
Temgire SD, Garje SS, Khare VV. Mucosal burning: A case report of rare finding in maxillary sinus carcinoma. J Indian Acad Oral Med Radiol 2021;33:333-5

How to cite this URL:
Temgire SD, Garje SS, Khare VV. Mucosal burning: A case report of rare finding in maxillary sinus carcinoma. J Indian Acad Oral Med Radiol [serial online] 2021 [cited 2021 Nov 29];33:333-5. Available from: https://www.jiaomr.in/text.asp?2021/33/3/333/326880




   Introduction Top


Malignant tumors of the maxillary sinus are rare, attribute to 1.5% of head and neck cancers and are twice as common in men than women. Nearly 95% occur in patients over 50 years of age.[1] Early clinical features are often misdiagnosed and treated as sinusitis giving a poor prognosis. Since the burning entity is not mentioned in any literature, attention should be given to the same for understanding the importance of differential diagnosis of such lesions. Distant and regional lymph node metastases are rarely seen, irrelevant of tumor size. Metastases usually indicate a tumor-dependent death shortly.

Patient information

An 82-year-old man reported to the department on 14/01/2020 with a chief complaint of a severe mucosal burning sensation (MBS) associated with swelling in the upper-right maxillary region for 18 days. Initially, he experienced mild MBS for a week. Later, the severity increased day by day until it became unbearable [Table 1].
Table 1: Timeline of the history

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Clinical description

A diffuse, oval, firm, afebrile, mildly-tender, fixed, and noncompressible swelling extending superiorly from the lower border of the orbit and inferiorly along the angle of the mouth, approximately 4 × 3 cm in diameter, with overlying smooth skin. The edentulous ridge of 16, 17 regions had healed satisfactorily [Figure 1].
Figure 1: Diffuse swelling in mid-face region. Smooth mucosa over the edentulous ridge

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Therapeutic intervention

The patient was prescribed medications and recalled [Table 2]. As no positive response was seen from medications, he was immediately advised hematological investigations (results were normal) and a computed tomography (CT) scan of paranasal sinuses. He got 16-17 teeth extracted due to mobility, on 14/12/2019. His medical, family, and habit history were noncontributory.
Table 2: Therapeutic intervention

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Diagnostic assessment

Radiological reports including occlusal, panoramic, and CT were analyzed revealing neoplastic or inflammatory etiology [Figure 2]. Resorption of anterolateral and inferior medial walls along with the destruction of alveolus was seen. CT was satisfactory to know the boundaries [Figure 3]. Further radiological investigations were, hence, not considered. Based on history and clinical and radiological findings, a differential diagnosis of malignancy arising in MxS, which is secondarily infected, was considered. The tumor was clinically staged as (tumor, nodes, and metastases) T3N0M0 under-2009 Union for International Cancer Control system. Later, an incisional biopsy revealed high-grade carcinoma on histopathological examination.
Figure 2: Greater pneumatization and destruction of buccolingual cortex. Destruction of right MxS floor. Heterogeneously enhancing soft tissue lesion

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Figure 3: Obstruction at infundibulum. Destruction of the alveolus. Bony margins destruction. Mucosal thickening

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Follow-up and outcome

The patient was advised a panel of immunohistochemical tumor markers with chemotherapy and/or surgical treatment options. He declined further treatment; therefore, he was advised palliative management, mainly targeting the unbearable MBS relief and nutritional needs. Sadly, he succumbed in a few days.


   Discussion Top


The behavior of exposed malignant cells is dependent on the environment to which they are exposed too.[2] MxSCa is rare.[3] In most western countries, the incidence of oral cancer is relatively low.[4] In developing countries like India, the third most common site of malignancy is the mouth and throat region.[3] 80% of all HNC originates from MxS and 60%–90% of those histological varients are mostly comprised of epithelial cell carcinomas.[3]

Alcohol and smoking habits are risk factors in the development of epithelial cell carcinoma of the oral cavity. MxSCa is extremely infrequent and the treatment proffers many challenges to the HN surgeons, radio oncologists, and oncologists.[5] Earlier literature also mentioned that symptoms are detected when walls of the MxS are eroded by the malignancy leading to obstruction in the nasal airway, bleeding from the nose, puffiness, and facial tenderness.[1] As the symptoms are nonspecific and familiar, usually, they are misdiagnosed as benign sinonasal disorders.[1] Lesions generally are detected late and first diagnosed at a very advanced stage. Early clinical features are often misdiagnosed due to close anatomical proximity to the vital structures, by the occult growth within the facial skeleton, and the lesions remain asymptomatic for a long time. The reason for the delay in clinical symptoms is the presence of an enormous air space that permits the asymptomatic expansion of the tumor.[7]

During the medical diagnosis of MxSCa, it is significant to incorporate primary sinonasal neoplasms like nasopharyngeal-Ca, undifferentiated-Ca, esthesioneuroblastoma, lymphoma, metastatic diseases as-well-as adenocarcinoma of minor salivary gland origin.[3] Studies from literature showed a significant increment of neck-metastases once the tumor invades the mouth. HNC management involves the accurate staging of the disease extent, with the help of CT or MRI, following the TNM malignancy classification and ascertaining the feasibility for surgical resection. Induction chemotherapy in locally advanced sinus cancers increases the likelihood of tumor downstaging and complete resection with orbital preservation.[8] Prompt diagnosis is paramount for a good prognosis. The 5-year survival rate has remained unchanged, ranging from 35% to 40% approximately.[9]

Limitations and Future prospects

In our case, neither the edentulous area was not much redolent of malignancy nor the above-mentioned symptoms, except swelling, were present clinically. Unbearable MBS in unilateral maxillary swelling was experienced in the terminal stage of MxSCa. These lesions are extremely invasive.[6] Similarly, in cases of vague unilateral symptoms, especially which last for more than 4 weeks, adequate diagnostic procedures should be made.[1] Panoramic radiography often identifies the destruction of the MxS walls, especially the inferior-antral wall. But in advanced cases, for manifestation of early bone destruction, this imaging modality is not ideal. CT is the top-notch investigation in such circumstances. The core reason for CT being advised in such cases of MxSCa is for better imaging to depict the penetration of structures afar from the site of origin.[3] During CT studies, of soft tissue masses in the MxS cavity, more than 70% of cases show bony destruction.[10] Detailed bone involvement is provided more on CT than magnetic resonance imaging (MRI).


   Conclusion Top


Patients sometimes can be ignorant about the symptoms of the disease as these diseases are asymptomatic. An astute physician may diagnose MxSCa at an early stage and immediately extend treatment. Attention should be given to all MBS entities, as clinical signs and symptoms may masquerade as an inflammatory condition that may later undergo malignant transformation and delay the diagnosis. Proper investigations including CT and prompt treatment plotting may improve the mortality and morbidity rates of the patient. Given the low incidence of MxSCa and the diverse pathologies, it is extremely difficult to compare different treatment approaches.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kreppel M, Safi A-F, Scheer M, Nickenig H-J, Zoller J, Preuss S, et al. The importance of early diagnosis in patients with maxillary sinus carcinoma. Eur Arch Otorhinolaryngol 2015;273:2629-35.  Back to cited text no. 1
    
2.
Leef G, Thomas SM. Molecular communication between tumor-associated fibroblasts and head and neck squamous cell carcinoma. Oral Oncol 2013;49:381-6.  Back to cited text no. 2
    
3.
Praveena NM, Maragathavalli G. Carcinoma of the maxillary antrum: A case report. Cureus 2018;10:e2614.  Back to cited text no. 3
    
4.
Moore SR, Johnson NW, Pierce AM, Wilson DF. The epidemiology of mouth cancer: A review of global incidence. Oral Dis 2000;6:65-74.  Back to cited text no. 4
    
5.
Turner JH, Reh DD. Incidence and survival in patients with sinonasal cancer: A historical analysis of population-based data. Head Neck 2012;34:877-85.  Back to cited text no. 5
    
6.
Manrique RD, Deive LG, Uehara MA, Manrique RK, Rodriguez JL, Santidrian C. Maxillary sinus cancer review in 23 patients treated with postoperative radiotherapy. Otorhinolaryngol 2008;59:6-10.  Back to cited text no. 6
    
7.
Ramachamparambathu AK, Vengal M, Mufeed A, Siyo N, Ahmed A. Carcinoma of maxillary sinus masquerading as odontogenic infection. J Clin Diagn Res 2016;10:ZD11-3.  Back to cited text no. 7
    
8.
Won HS, Chun SH, Kim BS, Chung SR, Yoo IeR, Jung CK, et al. Treatment outcome of maxillary sinus cancer. Rare Tumors 2009;1:e36.  Back to cited text no. 8
    
9.
Myers LL, Oxford LE. Differential diagnosis and treatment options in paranasal sinus cancers. Surg Oncol Clin N Am 2004;13:167-86.  Back to cited text no. 9
    
10.
Vasudevan V, Kailasam S, Venkatappa M, Devaiah D, Radhika MB, Shrihari TG, et al. Well-differentiated squamous cell carcinoma of maxillary sinus. J Indian Aca Oral Med Radiol 2012;24:253-7.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

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